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to be effective or harmful in other jellyfish envenomations. Once inactivated, remaining
stingers should be plucked off with gloved fingers or forceps. Dried nematocysts may be
re-activated by water exposure so stingers should be physically removed and not washed
off. Pressure immobilization bandaging as used in Elapid snakebites may be useful first
aid, especially in box jellyfish envenomation.
B. Venomous Fish Stings: Many fish and rays possess sharp stinging spines capable of
causing local trauma and through injection of venom intense local pain. Deaths have been
associated with many species either due to direct local trauma or to the effects of
envenomation. Secondary local infection and local tissue damage is often described.
Retained local foreign bodies are common.
Pain relief in these cases is usually obtained by immersion of the affected area in
hot water. Whether this technique works by venom neutralization or other local effects is
uncertain. Care must be taken to test the hot water beforehand. The water should be as
hot as can be comfortably tolerated (104-110° F, 40-43° C), but not so hot as to cause
burns, particularly if the area is anaesthetized. Narcotic analgesia or injected local
anesthesia may be required to ensure pain control. Anti-venom, which is injected IM, is
available and is effective against stone fish. Any venomous fish sting requires careful
wound examination and even surgical care to ensure retained foreign bodies are avoided.
C. Sea Snakes: Bites from these creatures are a common cause of envenomation on a
worldwide scale, especially in the Indo-Pacific regions. Sea snakes are generally non-
aggressive and will only attack if provoked or interfered with. The effects of their venom,
clinical manifestations and treatment are the same as for other Elapid snakes (see Reptile
Envenomations). In particular, pressure immobilization bandaging and rapid transfer to a
medical facility for specific anti-venom therapy may be life saving.
D. Mollusk Envenomations: The two most notable are coneshells and blue ring octopus,
both of which may inject rapid acting neurotoxins. These produce a progressive paralysis
that has been associated with a number of deaths. The key to management is recognition
and support of ventilation (using mouth to mouth in the field if required). Pressure
immobilization bandaging may help to limit venom spread and the onset of toxic effects
(see Reptile Envenomations).
E. Marine Poison Ingestions: On a worldwide scale these are likely to be the single
largest cause of mortality associated with encounters with marine creatures. Poisoning
with tetrodotoxin occurs from eating the flesh of incorrectly prepared pufferfish ("fugu").
Although slower in onset, the manifestations and required management will be similar to
that seen with blue ring octopus envenomation. Again the key life saving intervention is
artificial support of ventilation.
Paralytic shellfish poisoning is due to ingestion of mollusks that have themselves
ingested and concentrated the poison saxitoxin that is produced by microscopic
dinoflagellates. This toxin produces a rapid onset of paralysis that is managed in the same
way as pufferfish poisoning (see above).
Cigautera poisoning occurs from eating fish that have concentrated toxins passed
up the food chain from dinoflagellates. The illness is particularly common in parts of the
